The reconstructive burden of inter-hospital transfers: resource utilization and clinical implications in tertiary...

Despite the presence of well-established trauma centers, many trauma patients are transferred due to unresolved wound complications. This often-overlooked issue highlights the critical need for specialized wound management and the essential role of plastic surgery (PS) in regional trauma centers. This study aims to emphasize the importance of effective wound management in trauma patients and examine the clinical outcomes of interhospital transfers.

We performed a retrospective chart review of 92 trauma patients transferred to a regional trauma center from January 2020 to February 2022. We evaluated the injury severity score (ISS), initial resuscitation, and post-transfer treatment. To assess the clinical burden, resource utilization-including surgical intensity and length of stay (LOS)-was compared between the PS-involved group (n = 32) and the control group (n = 60).

Notably, 41.1% of patients were transferred from certified tertiary hospitals, indicating that even well-equipped facilities face challenges in wound management. Among the patients, 34.8% required specialized consultation with the PS department, with facial fractures (50%) and lower extremity skin defects (34.3%) being the most common indications. Compared to the control group, the PS-involved group required significantly higher surgical intensity (1.82 vs. 0.92, p < 0.001) and longer post-transfer hospitalizations (24.6 vs. 14.2 days, p = 0.002). These surgeries required approximately 2 operative debridements and 13 specialized wound care sessions per patient, underscoring the intensive care required for effective wound management.

The increasing rate of inter-hospital transfers between tertiary centers underscores a critical need for specialized wound management. Our findings suggest that unresolved reconstructive needs are significant factors associated with these transfers, necessitating specialized plastic surgery involvement. Rather than a failure of management, these transfers may represent a proactive triage strategy for optimal care delivery. Integrating plastic surgery into trauma systems can optimize resource utilization and enhance the overall effectiveness of regional trauma care.